Trying to Cure the Logistics of Health Care

Grant Sends GMU Expert to Teach Doctors and Staffs to Coordinate on Chronically Ill

A George Mason University professor has been awarded a grant to train physicians, nurses and others to better manage the complicated treatment of those with chronic illnesses such as hypertension, diabetes and heart disease.

Studies have shown that, increasingly, physicians and people with chronic illness are dissatisfied with the health-care process, including problems in communicating results of examinations, coordinating follow-up care and ensuring that orders for prescriptions are followed.

So Mark Meiners, a professor of health policy in the College of Health and Human Services at GMU, received a grant of more than $500,000 to train a group of doctors and their support staffs in San Diego to address those concerns. The training will include making earlier contact with patients to prepare them for visits and communicating with other providers to make sure patients receive proper follow-up care. He will use a record-sharing computer program designed to help health-care professionals communicate seamlessly with other professionals about individual patients.

Meiners, a national expert in the logistics of long-term care, was scheduled to start this week. He said he hoped the training will serve as a model for other communities, including those in Northern Virginia. The $535,000 grant was awarded by the California Endowment and the Alliance Healthcare Foundation and builds on an earlier grant awarded to Meiners. The study from that grant found that physicians cited lack of coordination of care as a major obstacle to treating patients who are poor, disabled or chronically ill.

"There's a huge amount of frustration among patients and physicians these days because people feel underserved, under-appreciated -- and so all of this is looking for ways to overcome some of those barriers," Meiners said. "Particularly for people who need a lot of health care, we're gong to need a lot of coordination."

A major obstacle for health-care professionals is making sure that chronically ill patients have access to the care they need, he said. Meiners's training will stress, for instance, the need for early outreach to make sure patients have adequate transportation to get to appointments. This, he said, could lead to fewer missed visits, which could save the health-care system money. He also will train care providers on making sure that home health aides are dispatched when necessary and making sure that pharmacists know when a patient is supposed to come in and get medication.

Studies have shown that the absence of this kind of communication contributes to frustration about the health-care system. For instance, in a 2005 study of 150,000 people by the Massachusetts Health Quality Partners, 40 percent of adult patients reported that their primary care doctors were not always up-to-date and informed about care patients receive from specialists. More than one in four patients reported that at least once in the preceding year, a doctor's office had ordered a test and not shared the results.

"The cost for dealing with chronic care issues is large and it's growing, and we know lack of coordination of services results in expensive things like unnecessary hospitalization," said Gregory Hall, senior program officer for the California Endowment. ". . . We need to come up with innovative cost-saving measures, just to deal with what we have now."